West Virginia Bound
In a Dodge minivan, every nook and cranny packed, our seven member team departed from Atlanta early Sunday morning, bound for the tree-covered mountains of West Virginia. We knew little of what to expect over the next two weeks as we watched the surroundings transform into rolling hills. We knew only of our destination: Cabin Creek Health Systems (CCHS), a network of rural clinics delivering primary care to the under-served mining communities in the counties outside of Charleston, WV. We are all in our last semester of the Emory ABSN program. After a year of metropolitan hospital clinical experience, we were ready to get a taste of rural primary care – with all of its challenges and surprising rewards. We were also bound together by a mutual curiosity about the culture of these West Virginian mountain communities, which heightened our anticipation for what this experience would hold in store for us.
After a warm welcome from the CCHS director, Craig Robinson, his wife Judy, and the CCHS education and program coordinator, Amber Crist, we eagerly listened to the project idea they have outlined for us. As a continuation of their unceasing, and innovative journey to improve the quality of their patient care, they organized a two-day orientation and training to introduce us to the richness of the local culture, and to acquaint our team with a methodology of obtaining oral histories. The idea behind this training is to equip us with an effective tool with which to untangle the complex web that characterizes the health of these communities.
Our arrival at the CCHS administrative offices early Monday morning was greeted by the gentle strumming of a pair of guitars as voices rose in the wholesome harmony of Appalachian ballads. That was the opening to our immersion into the local culture, seeing for ourselves the environmental and social impact that strip and deep mining have had on this area.
Within a culture that values land as their identity and their heritage, a seemingly incurable pain comes out when family land is taken or destroyed. A majority of this population struggles with what Amber calls the West Virginia Quad – hypertension, hyperlipidemia, obesity, and diabetes. Dr. Westfall, a family practice physician who serves with CCHS, added two more co-morbidities to the group – pain and depression. The harsh and violent reign of coal mining has left its mark upon the hearts of both the mountains and the families who have called them home for generations upon generations. Dr Westfall offered a new perspective when I asked about her most rewarding experience in working with these community individuals. She paused for a few moments, deep in thought. “It is hard to pick one out,” she said. “Being with the people. Seeing their strength and resilience. I may not see the good outcomes, but I do see their strength. And I get to sit with them through it.”
Michael and Carrie Kline, a couple who have dedicated their lives to listening to the stories of Appalachian miners and giving the voiceless a voice, lead us through a condensed training in eliciting an oral history. Theirs is a specific methodology that transfers the power of the telling to the teller. It is not driven by questions, but by the power of merely listening. For two days we wrestled through this possible new approach to obtaining a health history; an approach that places the patient truly at the center, enables the listener to see the individual within their own social context, and to hopefully elicit goals, values, and knowledge without the prodding interrogative questions. This afternoon, at the end these two long days, volunteers from the community came to be interviewed. We practiced the skills we had learned, framing the interview as a time to talk about their life and community health. We opened with the statement “Tell me about your people and where you were raised.” At the end, when we were collecting our thoughts, we all realized that we have a lot of work cut out for us over the next two weeks, working through this new technique and discerning how this could possibly be used within the CCHS patient care. Stay tuned as we discover what happens to an individual and a community when they share their story, and what that can mean to their health and well-being.